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Where’s The Human in Infrastructure? with Marianne Lefever

Date Published: November 30, 2021

How we design our cities has a huge impact on people's health and wellness. In a recent series of articlesMarianne Lefever explores the complex interconnections of health and infrastructure, and the challenges and opportunities facing cities around the world.

We speak with Marianne Lefever, a healthy city design expert, about the opportunity to transform cities to improve the quality of life for every person living within them. This is what she calls a smart and healthy city and involves the integration of body behavior and environment into infrastructure decision making. Marianne is an architect, futurist, and healthy city design expert. She has years of experience in climate mitigation and sustainable city design in Europe and North America. After an interesting career as a structural engineer, renewable energy consultant, and futurist, she returned to her first love of city design. As a Cofounder and managing partner at Healthy City Global, she’s transforming cities around the globe into healthy environments and communities. Welcome to the show, Marianne. I’m glad to have you.

Thanks, Jen.

I am curious, you’ve got an interesting background. Can you share a little bit about your story and journey of how you’ve got to where you are in your career path, which is different from where you started?

It’s been an interesting journey. I started off as an architect, but I sat on all sides of the table. I worked in design. I worked in civil engineering. I worked in real estate development. I’ve been all around the construction world. My focus has always been on sustainable design. Graduating in the early 2000s, was a hot topic but there was still so much to be done. I spent the first half of my career on that sustainability. What I started to notice over the years was that we approached sustainability and climate mitigation and all of that from such a brainy perspective, like infrastructural, engineering. Coming from an engineering background myself, I saw it. I bought into that.

Over the years, things changed a lot when I became a mom. When I had my daughter, it changed my perspective. I started to realize that there would be a good chance that we end up with these super climate-adapted cities, high tech, with a lot of unhealthy and unhappy people in them. Over the decades, I feel like we completely forgot about people. We build our cities for people, that’s the core of it. When you think of it, take away mobility in a city, there’s still a city and people will find a way to get around. Take away greenspace is not ideal but people will still get around and find ways to hang out and things will pop up. Take away the people in a city and there’s no city left. It’s a ruin. Ultimately, we build our cities for people. I felt like there was this huge blind spot in all of our sustainability work and all of our city design and it was the human-centred part of it.

I started looking into what is that relationship between people and the city? How should that be established? How should we look at it? I started noticing years ago that there was this increased focus on the impact of our cities and the built environment on our health and well-being. It all started more on a building level at first. It was like, “Fitwel certification is starting to pop up.” My background is in city design and that’s where my passion is. I started to think about, “What does that mean on a city scale? How are we influencing positively or negatively people’s health and well-being by the way we design our cities and we organize our cities?” This whole pandemic happened and then it became crystal clear that it’s been a huge blind spot. It’s something that we should start focusing on much more.

When you started to think about this relationship more in-depth around people and how they interact with the city and how it impacts their health and well-being when you started talking about that, were there many people around you in that same space who were thinking in that same way? Were you finding people were surprised and it was a new topic for them to be thinking about?

It was lonely in the beginning, for sure. I felt like I was onto something, but I also wondered if I was crazy sometimes. I was like, “Why is nobody else seeing this? Am I missing something?” I started noticing that the more I looked into it, the more I found academic research that was emerging and ongoing studies that hadn’t been published yet, but that was happening around the link between air pollution and children’s development. Also, the link between air pollution and dementia and Alzheimer’s, for instance. I was like, “I’m not the only one here. Other people are catching up on this too.”

The funny thing is that ever since I started going down this road, everyone I speak with immediately gets it. From a sustainability perspective, it’s a much more intellectual debate. People are like, “I know. We should, but it’s a little harder.” If it comes down to our own health and well-being and the health and well-being of those close to us, it’s a no-brainer. I always ask people who are a little hesitant in the beginning. I’m like, “Do you want to live in a resilient city?” People go like, “What’s a resilient city? What does that even mean?” When you ask people, “Do you want to live in a healthy city?” Everybody is going for a debate, “Yes. Sure. I don’t want to live in an unhealthy city, not by choice.” It’s an easier conversation to have, even with people who aren’t well versed on the topic. It makes sense. It’s about common sense.

You also mentioned when you became a mom and how that changed your perspective. You’re living in both Europe and North America at times. As a parent and as a mother, what is your diverse experience? What does that bring to the way that you view your work? How does it impact your clients?

It started with a question that a friend of mine asked me when I was pregnant. He asked, “What kind of environment would you like your daughter to grow up in?” I sat there and I looked at him and I was like, “I’m drawing a blank here. I have no idea. I never thought about it like that.” I was up in my head with all the engineering solutions that we were coming up with and I never stopped to think what it meant from a user experience. Being challenged with that question made me think about it. I kept pondering on it for days. That’s what I do with my clients too. It’s not much about the infrastructure or the big lines. It’s about, this is your city that you’re living in and that you’re building in. If you would be using this building or you would be living in this neighbourhood, what would you like the experience to be?

Sometimes if I go to a public speaking engagement, I do this visualization exercise where I ask people, like, “Close your eyes and think for a minute. What would your ideal neighbourhood look like?” It’s interesting because some people are sad afterward. They’re like, “I realized my neighbourhood looks nothing like what I would like it to look.” Others are happy because they’re realizing that they live in a pretty healthy neighbourhood and they have a good sense of community and social cohesion and all of that. It’s interesting to see how it resonates with people.

To your point of having that experience of living in North America and Europe, the way I look at it is that I loved my time in North America until I became a mom. It’s interesting. I had such a vibrant life living in North America and going places, but then I became a mom and I realized that there was this, in my perspective, a funny notion that when you have kids, you move to the suburbs. The city is no place to raise kids. I was being as stubborn as I am. I was not agreeing with it. I was like, “No. I’m an urbanite. By blood, this is who I am. I want to stay in the city.”

Moving to Europe, I live in the Netherlands, the quality of life for children is pretty high here because there is this idea that children can roam around freely and that was something that was missing in North America. There was no place to go with your kids apart from the playground, but that was it. It was strictly defined, “This is where children can play.” Whereas here, the cities are also for children. There’s room for improvement, but it’s a way we think about it and that’s important in how we design our cities and our neighbourhoods.

It’s not about having a place for every age group or every ethnicity or whatever group we’re looking at. It’s not about, “This is where you go,” so everybody has room. It’s more about, how can we design cities and neighbourhoods that allow people to roam freely everywhere so everybody feels included? It’s a different approach to looking at it. When you think about what makes up a healthy neighbourhood, a playground is nice, but it’s also about getting there.

If my daughter cannot walk to the playground in a safe way or I have to take a car, even worse, to get to a playground, that’s not a healthy neighbourhood because that means I’m not exhibiting healthy behaviour. I’m not able to walk or cycle and get some physical exercise while I’m going to the designated child’s area. In my mind, a healthy neighbourhood is a place where children can play outdoors freely like I used to do when I grew up. We would roam the fields behind our house and play on the street and it would be fine. That was also a designated area for kids. Everybody was okay with that, but that doesn’t seem to be the case anymore. We need to find a way to get back to that.

It’s such an interesting look at the idea of city design and that integration piece. It does make me think of the importance of having your perspective at the table as a mom, parent, someone who’s lived in two different continents, has lived in cities. Having your voice at the table along with other voices speaks to the importance of diversity. Bringing those points of view to make sure that as we go forward and we look at the design, whether it’s a building or city, we are thinking about that bigger picture and how we’re impacting the people living in it. A lot of people approach that more from an engineering brain standpoint and less from how does it feel when you’re out there. How do you interact with that space if part of that is missing?

Years ago, I got to watch Canadian Olympian Donna Vakalis. She’s a pentathlete and she was talking about indoor air quality. What she was relating to was when she would do competitions, they would go swim and she had noticed that there were fast pools and slow pools. There was something about the pool in particular that they knew. Sometimes because that pool was fast and cool. It got her thinking around and athletes know that. That was a well-known thing. When you went into certain facilities, that was how it was.

She was fascinated with air quality and this idea of has anyone thought about what’s the air quality? Is that helping me be a better employee? Do I have enough fresh, clean air to breathe with the temperature and thermal comfort? That was an interesting perspective, for me. Do you think about people’s performance too? How does that fit into your scope of what you think about in your day?

That’s a good point you raise about indoor air quality and productivity, employee productivity. There’s quite a lot of attention to those topics at the moment. What I tend to tell my client is that your building is not a bubble. Yes, you can have great indoor air quality, good lighting, and the best productive environment for your employees. If they’ve been commuting in a car and stuck in a traffic jam for two hours, one way, that has a much higher impact on their productivity than the indoor air quality in your building. There is much more that ties into, for instance, employee productivity than what happens in the building.

As an employer, I would look at it from the whole day in the life of an employee. Where do they live? Do they get enough sleep? Is their circadian rhythm disturbed? It is a huge impact on productivity. How do they get to work? Do they have the ability or the option to walk or cycle to work? If they do, do you provide the facilities in your building so that you can support that behavior? For instance, do you have cycling parking on the ground level and not minus five in the parking lot? Do you have showers that people can use when they cycle to work? It’s simple stuff like that.

There is a lot that a building owner can do on a building level that ties into the broader picture. How are your people coming and going to work? If you walk or cycle to work in the morning, it raises your concentration level for up to four hours. That’s half a day. That’s huge. If you can disconnect from all your electronics over lunch, do some gardening on the rooftop or in the courtyard or patio, that has a huge impact on stress levels and productivity, on anxiety, on depression, all of that. We’re seeing exponential rates of absenteeism but also something called presenteeism where people are at work but they’re not in their full capacity to work. It’s a huge cost for companies. Anything we can do to improve that is a huge financial gain and a huge health and well-being gain. It’s important to look at it from a broader perspective.

I was talking about that for our increased concentration level. That also goes for schools and for kids. If our kids can walk or cycle to school, it has the same effect on their performance in school. When we think that it’s safer to drive our kids to school and all line up our cars in front of the school, we’re starting to realize that behaviour is making sure that their concentration levels are lower. Also, we’re creating peak air pollution in the morning and the evening around schools. We’re hampering your health and well-being because we’re increasing their risk of asthma, for instance. What we think is healthy behaviour doesn’t always line up with what our body thinks is healthy. We’re starting to understand that relationship better and better now that all this academic research is emerging. When it comes to productivity, for instance, there is a lot to be done on more of a neighbourhood or even a city scale.

My brain has always thought more about an individual building and less about the macro environment around. For an owner having to think about choosing the location of your office, if you’re looking at purchasing or building, what does that do in terms of location for employees? What are you surrounded by? It’s interesting to look at it at a higher level. That leads to this idea of municipalities and then private building owners. Municipalities, we would think at the macro level. They should be thinking about urban planning design around how many parks and schools and where they’re located. You’ve got individual building owners who are thinking about their employees. It would be best if we could mesh the interests of those two together. You need to mesh the two together to build healthy cities. That would be the end game.

We need to mesh these two together and there’s a whole lot of other things we need to mesh together. A good way to look at it is that over the past decades, we’ve come to look at our cities as this gigantic stack of layers. There is a layer of infrastructure, like road infrastructure. There’s a layer of mobility. There’s a layer of utilities. There’s a layer of buildings. There’s also a layer of people. There might still be a layer of nature somewhere. We also have a digital layer that has a spatial impact. Don’t ever let somebody fool you and say that smart cities are only virtual. They do have a significant spatial impact. The more years we added over the decades, the less space there was for people in nature.

If we want to go back to a healthy living environment, we need to make as much room for people in nature as we can in a city. We’ll only be able to do that by starting to look at a city as the interconnection of all these layers and not a stack. It’s not stacked. They don’t operate individually. They’re all interconnected. When we start to look at it that way, there are some interesting additional benefits or multi-benefit solutions that you can come up with that benefit individual or private owners, but also benefit municipalities. We need to get rid of the idea that it’s either/or.

When I talked to building owners, they’re like, “I can only do something in my building or on my plot of land because that’s where my responsibility lies. I cannot say that there needs to be a cycling infrastructure or a green space in front of my building.” That’s not entirely true, is it? There is always a discussion to be had. If you own or if you’re planning and building in a neighbourhood, that building will have a significant impact on that neighbourhood.

We’re seeing more and more building owners that are starting to talk to the neighbourhood before they start the design process. What is the neighbourhood looking for? What are they liking today? What’s working well and what can they tap into? Where is the room for improvement? How could a building owner, with their own building, contribute to that opportunity space? If we look at it like that, if you look at the planning and design process more as a conversation to be had with different parties, local participants in the neighbourhood but also on a municipal level, then you can come up with solutions that link one and one together.

Maybe the municipality was already planning improvement in cycling infrastructure. They didn’t think about prioritizing your neighbourhood. If you say, “Here’s a missing link that would help X amount of people walk or cycle to work or to school. It would alleviate traffic, which is great for the new municipality, fewer road repairs, and less air pollution. There’s always gains to be had on both sides. We need to look at it as an integrated discussion. We need to think about co-benefits much more than we do now.

The funny thing is, as with everybody, but definitely would help the city design, the one that is investing is not necessarily reaping the benefits. For instance, when working with municipalities, often I get a response, “A park is costly to maintain.” On the other hand, you’re creating more real estate value for the real estate around it. Somebody is reaping the benefits. You’re creating a lot of health benefits on being more physically active, children, people of all ages, which is reducing your healthcare costs. The health care department is also getting a benefit. Once you start to pile on all these co-benefits, it becomes a different story. It’s not so much about, we’re investing and not getting anything in return. There are returns. They might not be in your department. It’s going to be more crucial to pool resources and think about co-benefits. Who’s investing? Who’s gaining? How can we restore a balance there?

That comes back to the big picture of thinking because of many departments. This is the way it is in lots of industries, the construction industry in particular, but this would also be the way to municipalities. People operate in silos. To your point, co-benefits is likely not something discussed or looked at in the way that it should be because that department is not getting the benefit. In fact, it may be not even that department, it could be the health piece of it. People that are healthier body-wise, needing to use hospitals less. Oftentimes, municipalities have are completely different departments. It’s different than the health system. That is an interesting idea. How do we get people to start to think at that macro level? Do you have any examples where some municipalities have spent some time and done the work that has helped business? Maybe those are some of the stories we need to be spreading a bit more.

There are quite a lot of interesting examples on different scales. When we go to your big macro scale, Paris is a great example. Mayor Hidalgo got reelected in Paris. One of the cornerstones of her reelection campaign was the fifteen-minute city. It’s called chrono-urbanism and it’s popping up in a lot of places. Ottawa is experimenting with it and some other cities around the world. The fifteen-minute city starts from the idea that within fifteen minutes of walking or cycling from your house, you should have access to everything that allows you to lead a full and healthy life. That doesn’t only mean access to health care, a job, education, but it also means access to healthy food. It means access to green space, to leisure opportunities, to culture, to shopping, to good public transit. It’s about accessibility and proximity of services in the broadest sense. It’s about bringing back the village into our big cities. The benefits that those old villages had. That’s a big macro-scale example.

A more micro-scale example, a nice one that I like a lot is from Mexico City. It’s a big park that they made and it’s called Parque Lineal La Viga in Mexico City. It’s a huge park that was constructed because they had water management issues. They had issues with overheating in the summertime. They built a park to improve their water management and provide shade. It’s built for about 30,000 inhabitants within walking distance. There are another 4.6 million people that can reach the park with less than 30 minutes spent on public transit. It has a gigantic reach.

The park has been such a big success that they’ve noticed that because of all the people visiting the park, the neighbourhoods around the park are benefiting from it. A lot of the small local entrepreneurs and shops are seeing an increase in their economic activity. The park was crossing a lot of underserved socioeconomic neighbourhoods. They’re starting to flourish again. It’s an interesting example of how investing in public infrastructure, something as common as a park is creating a lot of benefits that go much further than being able to have a park nearby. That’s a great example too.

That’s a prime example of how a municipality can do the work. Although it’s going to be an effort for them to maintain that park, the benefit is broad-sweeping. Although the municipality would benefit as well when you have thriving public spaces, you have businesses that can continue to function. They pay property taxes. You have neighbourhoods that are safer when you have that thriving infrastructure. There is a benefit. You can’t directly link it back to that department that has to maintain that park. It’s interesting.

It doesn’t always need to be the municipality that’s taking the lead. Sometimes, it can be the people who are directly benefiting from it. Anyone who’s visited New York City once has probably been to Bryant Park. I love it. It’s my favourite park in downtown Manhattan. What I love about it most is that the park is completely funded or financed by a lot of the people who live around it, the hotels, the restaurants. A lot of people who have a stake in making that part as attractive as possible are the people who are investing in it. That cooperation that’s running and managing the park has been around for quite some time. It’s not like it’s a new thing. It’s tried and proven. Sometimes, maybe it’s about bringing different people together. Maybe the municipality only plays the role of being the glue between all those stakeholders.

Do you have any suggestions for people who are either building owners or municipalities? How do we make a change in this space? How do we get actionable change so that we have better communities, better cities, better buildings?

That’s the key question. What I always tell our clients is that it all starts with asking the right questions. The question we need to ask ourselves for every project we do as a municipality or as a private developer or a building owner is, “How will the project that I’m thinking about improve the health and well-being of the people using it, but also to community around it?” We have to be willing to seek the answers.

If we realize that the answer is either it won’t change anything or it will negatively impact the health and well-being, then we shouldn’t do it because that will also reflect on the project itself. We need to start by asking ourselves the right question. How will this impact the health and well-being of people? Research it. Look for the answers. There are more and more people that can help with finding those right answers because this is a growing market. It’s an emerging market, this whole health in the built environment space. There are a lot of answers to be found. We can realign our decisions and the way we set design requirements. We often design for a program or a certain budget. We design for economic growth or activity. We design for efficient infrastructure. In the future, a crucial design requirement should be the health and well-being of the users.

Marianne, it becomes clear that from my work, I tend to think a lot more in the micro and that building and less about the macro. If there’s anything I can take away from listening to you and speaking with you, it’s this idea of rising up and thinking about and asking that question of improving. How do you improve the health and well-being of people in your city and your building? What does it do? If the answer isn’t that you’re improving, then don’t do it.

We don’t always have to wait for the government to do work. There are examples of groups who have either improved parks in and around their space. We can be leaders in our own buildings and in the space around us and keep that conversation going. We likely need people at all levels. We need people in leadership, in governments, and the management of buildings. We also need people who are doing the work. We need both. We need that top and bottom pressure to make this happen and to make sure that human health is at the center of our design going forward.


I’m happy you could be with me. It was a fascinating topic and something that I know. I’ve learned a lot. It’s caused me to reflect on how I view buildings and space around me. I will certainly be asking the question as I look around, how is this building space improving human well-being? Thank you so much for spending time with me.

You’re welcome. It is my pleasure.

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